CORPORATE BROCHURE 2020 - Unity Health
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CORPORATE BROCHURE 2020 Unity Health is a division of Ambledown Financial Services (Pty) Ltd. FSP 10287 Underwritten by Constantia Insurance Company Limited, an authorised FSP 31111
Table of contents Unity Health provides a cost effective
primary healthcare solution to millions
Page 1 of South Africans unable to afford medical
- About Unity Health scheme coverage.
Page 2
To keep costs as low as possible and ensure quality care, Unity Health has
- The need for primary healthcare contracted with various private healthcare providers at discounted rates.
- Socio-economic benefits Focusing on the essential healthcare needs of the majority of South Africans,
our products are tailored to include the following categories:
Page 3
- Our service delivery operation
- Unity Health’s primary
healthcare network
GP consultations & Nurse Chronic medication Basic &
acute medications Consultations for specified medical emergency
conditions dentistry
Page 4
- Our wellness and employee
assistance programme
Page 5 Optometry Basic radiology Gynaecologist visits
& pathology & ultrasound
- Unity Health product range scans
for groups
Page 7
- Indicative monthly premium rates Specialist Hospitalisation Ambulance services Wellness
- Group underwriting rules Consultations for accidents & by road & air
emergencies
Page 8
- Frequently asked questions
About Unity Health
Page 10 Unity Health is a division of Ambledown Financial Services (Pty) Ltd.
Our commitment is to the millions of South Africans to ensure they have
- Distinguishing factors access to quality healthcare at an affordable price.
Our product focuses on the essential healthcare needs of most South Africans
Page 12
and includes a range of primary healthcare and hospitalisation benefits.
- Contact details
Approximately 85% of South Africans do not enjoy private healthcare as they
simply cannot afford medical scheme coverage. Our products are designed to
ensure they are affordable to the majority of South Africans.
Primary healthcare is the most essential medical need to most South Africans.
In the General Household Survey of 2018, more than 90% of households
required primary healthcare as their first consultation after becoming ill
or injured.
Our vision is to create access to private primary healthcare for the millions
of South Africans unable to afford medical scheme coverage.
Providing primary healthcare empowers and imparts knowledge, creates a
healthier and more productive society and advances societal development.
Page 01
The need for primary healthcare
Approximately 9 million of the total population of 58 million people are currently covered by medical schemes or about
15% of the population. The reason for the low take up in the medical scheme environment is two-fold – firstly, medical
schemes are prohibitively expensive and secondly, medical schemes cover largely in-patient hospitalisation benefits as
opposed to primary healthcare benefits.
Our products are designed to specifically address the issues of essential needs and affordability.
Our product focuses largely on primary healthcare
which includes access to general practitioners,
specialists, nurse, essential medicines for both acute 4.0 million
and chronic conditions, diagnostic services such as principals
pathology and radiology, basic and emergency dentistry,
optometry, health screenings and pre-birth maternity
benefits. Hospitalisation benefits for accidents 1.9 million Existing medical
and emergencies are also included in line with the Covered spouses/ scheme membership:
provisions of our Constitution which states that no
partners 8.9 million people
person shall be refused treatment for these benefits,
whether in a private or public setting.
3.0 million
children
Primary healthcare is preventative in nature and
References:
reduces healthcare and morbidity costs in the longer Quarterly Labour Force Survey, Quarter 2,
term. Individuals will enjoy a better state of health 2018 as published by Statistics South Africa CMS
and have greater knowledge and awareness of how to Annual Report 2017-2018.
better deal with an injury or illness. Employers should
benefit from having a lower rate of absenteeism, better 7.8 million
productivity and lower employee benefit costs in the principals
longer term.
Target market:
Unity Health has estimated that there are about 19.8 Not 4.0 million 19.8 million people
spouses/
million people who do not have medical scheme Covered partners not covered on a
coverage and where at least one person in the family medical scheme
has a job. This is more than double the amount of
people currently on medical scheme coverage.
8.0 million
children
See graphic representation of the existing medical
scheme market and the potential target market.
Socio-economic benefits
Creating access to private primary healthcare coverage for these 19.8 million people has
significant socio-economic benefits to the people of South Africa. These include:
1. Better quality of care and overall well-being for these individuals.
2. Better quality of care to the remaining uncovered lives as the public sector will have less people to service with
the existing infrastructure.
3. With greater access to care, patients will not need to spend time in queues at public facilities. This leads to an increase
in productivity and profitability to employers.
4. Primary healthcare is preventative in nature and results in a reduction in long-term healthcare costs. This will lead to
a reduction in employee benefit costs in the longer term.
5. As the private healthcare sector expands, a significant number of jobs are created in the healthcare and other sectors.
As this process gains momentum, GDP and tax revenues increase.
6. The expansion of private primary healthcare will encourage ongoing investment into the private healthcare sector
leading to continuous advancement in the quality of care - to the benefit of all South Africans.
Page 02
Our service delivery operation
Designing and pricing a simple set of primary healthcare benefits is an uncomplicated task.
Delivering a real service is far more demanding.
In order to make our product as affordable as possible For emergency transport services we have partnered with
we have established networks of general practitioners, ER24, undoubtedly one of South Africa’s top providers of
nurses, dentists, pharmacies, pathologists, radiologists emergency evacuation services. This includes a 24 hour call
and optometrists. Managing and expanding the provider centre to deal with emergencies. The 24 hour call centre
networks is an ongoing and onerous effort and as such we includes referrals to a medical hotline and trauma counselling.
have dedicated significant resources. Our current providers
consist of approximately:
• 2 700 network general practitioners
• 2 500 network dentists
• 2 700 network optometrists
To maximise our administration efficiency we have teamed
up with MIP to provide us with state of the art medical
administration systems. MIP is well known in the medical
scheme environment and provide system solutions and
support to numerous medical schemes. We receive claims
daily from various providers via switching companies and
thereafter claims are assessed and processed for weekly
claim payments.
One of our key differentiators is that all members are issued
We have an agreement in place with Mediscor to manage Unity Health membership cards. The membership card has
our pharmacy benefit. Mediscor sets out and manages the Unity Health and ER24 logo on it. The product has been
the formulary for both acute and chronic medicines. The designed to avoid any upfront or co-payments by members.
pharmacy benefit programme allows us to reduce the cost of When members visit their network provider, they simply
medicines and avoid co-payments to members. The chronic present their card and ID, and the provider in turn submits
programme ensures that the most appropriate medicine is the bill through to Unity Health for processing and payment.
provided based on the individual’s specific condition and
circumstance. In the event of an emergency, private ambulance services
will recognise the ER24 logo - an indicator that the member
Our optometry network is managed by Preferred Provider has private health insurance. Accordingly, the member will
Network (PPN), one of the leading optometry networks in be taken to the nearest private facility as opposed to a state
the country. facility (subject to emergency process flows).
7
Graphic representation
1
36 2
62
7
1
of Unity Health’s primary
15
122 44 18
2 32 18 2
5
5
healthcare network
10 1
27
30 18 29
17 22 16
26
11 4 74 10 5
5 90 65 245 7
4
40 144
4 3
12 2316 7 6
3
23 60 28 1
5 5 1
39
13 61 7 10 1 19 1
1 2 5 4 8
7 1 6 3 8 3 7 7 3
6 21 2 53 3 16
16 2 4
The Illustration Includes: 1
9
3
3
1
2
2
88
5
5 30
22
14
27
14 3
13
6
10
1
1 2 2 2
2 40 2 59
• General Practitioners 1 9 11
2 17 8
157 11 9
1 1 34
7 1 1 114
• Dentists
2
868
4
1 9
9
2 8
• Optometrists
3 1 6 14 43
6 2 2
2
2 1 3 1 1 5 5
• Pathologists 7
1 3
25 1
3 37
3 4 1 12
• Radiologists 5
4 2 8
22 64
22
5 9
1
26 37 23 10
39 11
4 42 17 5 1 200
736 6 20 28
35
10
Page 03
Wellness
Our wellness and employee assistance programme
One of our key objectives is to ensure that the health status of our members is managed in the
most optimal way. With that in mind we have partnered with the top onsite wellness provider in
our country, Reality Wellness Group.
Reality Wellness Group will arrange wellness days where The basic health checks and additional tests provide us
employees can have the following basic health checks: blood with useful information we can use to better manage the
pressure, cholesterol, glucose levels, body mass index (BMI), healthcare requirements of our members. Early detection of
waist circumference, HIV and pre- and post-test counselling. an illness coupled with appropriate disease management can
Additional tests include TB rapid testing, PSA screening, drastically improve the quality of life of an individual as well
breast light screening and optometry tests. as minimise the consequential healthcare cost burden.
A full report detailing the overall health status and In addition to the basic health checks, tests and vaccination
interventions of employees is shared with the employer programme, Reality Wellness Group will also provide our
group which in turn assists with health, absenteeism and members with unlimited telephonic counselling services.
productivity management. These services are available 24/7 by registered counsellors
who follow specific procedures and clinical protocols.
Employees unable to attend the onsite wellness days and Services include: Critical incidence / Trauma counselling,
their registered dependants can have the same basic health HIV counselling, Legal and Financial advice. Face to face
checks and PSA screenings at approved pharmacies (such as counselling can also be arranged for the member’s own
Clicks, Dischem & Pick n Pay). account.
Page 04
Product Summary: Groups
Primary Care Benefits
Benefits Plan A Plan B Plan C
3 visits per person per year 5 visits per person per year Unlimited
At any Unity Health Network GP At any Unity Health Network GP At any Unity Health Network GP
Pre-authorisation required for 10 or more
GP or Nurse visits per person per annum.
GP Consultations
We have over 2700 Unity Health network doctors nationwide. For your nearest network doctor call our Call Centre on 086 136 6006 or
search for a network doctor on your Unity Health App or on our website by logging into your member portal.
GP Procedures Minor procedures in doctors’ rooms are included in GP visits e.g. wound stitching, applying a cast to a broken arm, circumcision, etc.
Unlimited
3 visits per person per year 5 visits per person per year
Nurse consultations available at approved
Nurse consultations available at approved Nurse consultations available at approved
pharmacies (Clicks, Dischem & Pick n Pay) for
pharmacies (Clicks, Dischem & Pick n Pay) for pharmacies (Clicks, Dischem & Pick n Pay) for
minor ailments. In many practices nurses can
Nurse Consultations minor ailments. In many practices nurses can minor ailments. In many practices nurses can
provide scripts for minor ailments for up to
provide scripts for minor ailments for up to provide scripts for minor ailments for up to
schedule 2 medications.
schedule 2 medications. schedule 2 medications.
Pre-authorisation required for 10 or more
GP or Nurse visits per person per annum.
Limited to R1 200 per visit with an
overall limit of R2 500 per family per year.
Specialist Consultation No Benefit
Referral by Unity Health Network GP and
pre-authorisation required.
Dispensing GP: This means your GP dispenses medication and will provide you with the necessary medication.
Acute Medication
Non-Dispensing GP: Unlimited
Limited to medication prescribed during your Network GP visits.
This means your Network GP does not provide you with medication but will provide you with a prescription to collect your medication.
Available at approved pharmacies (Clicks, Dischem & Pick n Pay).
Chronic Medication Programme:
Chronic Medication Programme: 8 Listed “high impact”
27 Listed “high impact”
Conditions1 HIV/AIDS included.
Conditions2 HIV/AIDS included.
Chronic condition: A condition / disease that lasts for an extended period of time.
Chronic Medication Chronic Medication Programme: Your Network GP will assist you to register on the Chronic Medication Programme
with Mediscor.Your prescribed chronic medicines will be covered according to a set formulary. Find the chronic medication formulary (list) on
Mediscor’s website: www.mediscor.net. Approved pharmacies include Clicks, Dischem, Pick n Pay & Medipost.
1
Asthma; Chronic Obstructive Pulmonary Disorder; Diabetes Type 1&2; Epilepsy; HIV/AIDS; Hyperlipidaemia; Hypertension; Tuberculosis
2
Addison’s Disease; Asthma; Bi-polar Mood Disorder; Bronchiectasis; Cardiac Failure; Cardiomyopathy Disease; Chronic Renal Disease; Coronary
Artery Disease; Crohn’s Disease; Chronic Obstructive Pulmonary Disorder; Diabetes Insipidus; Diabetes Type 1 & 2; Dysrhythmias; Epilepsy; Glaucoma;
Haemophilia; HIV / AIDS; Hyperlipidaemia; Hypertension; Hypothyroidism; Multiple Sclerosis; Parkinson’s Disease; Rheumatoid Arthritis; Schizophrenia;
Systemic Lupus Erythematosus; Tuberculosis; Ulcerative Colitis.
Limited to R1 200 per person per incident
Basic & Emergency Treatment includes: full mouth assessment, intra oral radiographs, scale & polish, extractions,
No Benefit emergency root canal treatment, fillings, pain and sepsis treatment.
Dentistry Treatment
Only available at Unity Health Dentists. Specialised dentistry/treatment, such as bridgework
or crowns; orthodontic treatment; and dentures are not covered.
Optometry One eye test per person per year.
No Benefit A standard frame to the value of R254 and one pair of clear standard spectacle lenses per
person per 24 months. Available at PPN Network Optometrists.
Basic list of blood tests at a Designated Service Provider.
Pathology
Your Network GP must ask for these tests to be done. E.g. blood sugar or cholesterol tests.
Black & white X-rays only at a Designated Service Provider.Your Network GP has to refer you to have X-rays done.
Radiology
Specialised radiology such as MRI / CT Scans is not covered.
2 gynaecologists visits, 2 ultrasound scans per year. Limited to R3 000 per family per annum.
Maternity No Benefit
Pre-authorisation is required.
For Small Compulsory/Voluntary Groups: 1 month general waiting period, no pre-existing condition exclusions,
12 month waiting period for chronic medication & optometry and 9 month waiting period for pre-birth maternity.
Page 05Hospital & Emergency Care Benefits
Benefits Plan A Plan B Plan C
Overall Annual Limit No Overall Annual Limit
The actual cost of hospitalisation as an in-patient, including all associated services during the hospital admission at a private facility in the
event of injuries sustained due to an accident.
“What is an accident?
In-Patient Hospital An accident means bodily injury caused by violent accidental and external physical means. E.g. Severe injuries resulting from a vehicle accident or
Treatment working with factory machinery.”
Accident Only
Limited to R110 000 per person Limited to R225 000 per person Limited to R1 100 000 per person
per incident per incident per incident
Pre-authorisation is required Pre-authorisation is required Pre-authorisation is required
The actual cost of hospitalisation as an in-patient, in the event of an emergency that
necessitates the stabilisation of the patient before the patient is transferred to a public
hospital.
In-Patient Hospital
Medical procedures are excluded.
Stabilisation No Benefit
“What is an emergency?
Emergency Only
An event or unexpected health condition, which if not treated immediately would result in
death or serious bodily impairment. E.g. Heart attack/stroke.”
Limited to R22 000 per person per incident. Pre-authorisation is required.
Out-Patient Casualty The benefit payable for injuries sustained as a result of a minor accident shall be limited to treatment received in a hospital emergency unit.
Treatment Limited to R3 000 per person
Accident Only Limited to R6 000 per person per incident. Pre-authorisation is required.
per incident. Pre-authorisation is required.
MRI & CT Scans The actual cost of a MRI or CT scan necessitated as a result of an injury sustained due to an accident.
Accident Only Limited to R16 000 per person per year. Pre-authorisation is required.
Physiotherapy & Occupational therapy following an in-patient hospitalisation due to an accident.
Physiotherapy &
Limited to a period of 3 months following the discharge from an in-patient hospitalisation incident and
Occupational Therapists
limited to R3 000 per person per year. Pre-authorisation is required.
Accidental
No Benefit Limited to R10 000 per principal insured and first spouse dependant.
Death Benefit
Emergency Services Emergency Evacuation, including ambulance services (air or road)
Inter-hospital transfers
Repatriation of mortal remains
Telephonic Medical advice (Ask a Doctor ask a Nurse)
Unity Health push to call emergency dialling and find a provider app
No waiting periods for hospital care benefits.
Wellness Programme: Health Screenings & Employee Assistance Programme
Benefits All Plans
Onsite Wellness Screenings of employees is offered once per year for all employees. Health screenings include health checks for:
Basic Health Check:
• Blood pressure • cholesterol • glucose levels • body mass index (BMI) • waist circumference • HIV and pre and post test counselling
Onsite Wellness
Additional Tests:
Day Screenings
• TB rapid test for all high risk TB individuals • PSA screening once every 2 years for men aged 50 or older • Breast light screening available to all
females • Optometry: Eye tests
A full report detailing the overall health status and interventions of employees is shared with the employer which in turn assists with health,
absenteeism and productivity management. Limited to a minimum number of 15 employees per Wellness Day site.
For dependants and those individuals unable to attend the onsite Employee Wellness Day, the same basic health check and PSA screening is available at
Health Screenings Approved pharmacies (Clicks, Dischem & Pick n Pay). Employees can only access this benefit if they were unable to attend the onsite Wellness Day.
Employees do not have access to this benefit before the onsite Wellness Day has taken place.
Pap Smears Available once every 3 years after the age of 21 at Approved pharmacies (Clicks, Dischem & Pick n Pay). Your Network GP may offer Pap Smears.
Influenza: Available annually - needs to be administered by 31 May each year.
Tetanus: Available once every 10 years.
Vaccination
Hepatitis A & B: Available once-off.
Programme
Pneumococcal: Available once every 5 years for those aged 60 or older and for those individuals with medically proven compromised immune system.
Available at Approved pharmacies (Clicks, Dischem & Pick n Pay)
Unlimited telephonic counselling services are provided by registered counsellors who follow specific procedures and clinical protocols.
Employee
The service is available 24 / 7 and includes counselling for:
Assistance
• Critical incidence / trauma counselling • HIV counselling • Legal Advice • Financial Advice • Face to face counselling can be arranged for
Programme (EAP)
the member’s own account.
All Wellness and EAP benefits are included in the Primary Care and Primary Care + Hospital Care benefit options. For Hospital Care standalone plan options, only the EAP
programme benefits are included.
Page 062020 Indicative Monthly Premium Rates
BENEFITS PLAN A PLAN B PLAN C
PRIMARY CARE BENEFITS
Principal Insured R 215,00 R 282,00 R 330,00
Adult Dependant R 158,00 R 209,00 R 248,00
Child Dependant R 81,00 R 100,00 R 116,00
HOSPITAL CARE ONLY
Principal Insured R 89,00 R 129,00 R 149,00
Adult Dependant R 37,00 R 63,00 R 79,00
Child Dependant R 13,00 R 22,00 R 29,00
PRIMARY + HOSPITAL CARE
Principal Insured R 261,00 R 349,00 R 406,00
Adult Dependant R 188,00 R 259,00 R 308,00
Child Dependant R 89,00 R 116,00 R 137,00
Note: Indicative Premium rates are for Compulsory groups. Voluntary rates are approximately 5% higher than Compulsory rates.
Group underwriting rules
What is a group?
A group is defined as an employer group, trade union, bargaining council or any other grouping that may be acceptable to
the underwriting manager. Members of a group should be actively employed.
A group may also be defined as a sub-group of a group where the sub-group has specific features, for example, employees
or members within a specific location, earning within a certain income range, not having medical aid coverage or any other
sub-grouping acceptable to the underwriting manager.
Groups Underwriting Rules
Compulsory groups
A minimum of 20 principal insured members. No underwriting restrictions apply.
All members of the group must join.
Small / Voluntary groups • 1 month general waiting period
A small group is defined as a group of 2-19 principal insured
• 12 month waiting period in respect of chronic medication
members.
& optometry benefits
• 9 month waiting period in respect of maternity benefits
A voluntary group is where not all members of the group join.
Joining is therefore on an optional basis.
Underwriting restrictions may be removed or altered on request.
Page 07Frequently asked questions
Question Answer
Contact the Unity Health call centre on 0861 366 006 for a list of providers close to where the
member lives or works. Make an appointment with the provider and ensure the member presents their
Unity Health membership card and ID when they arrive for the consultation. You may also search for a
provider using the Unity Health app or the member can log into their member portal and search for a
How does a member access a
provider online.
primary care provider?
The Unity Health call centre is open during the following times:
• Monday to Friday: 08:00 to 17:00
• Saturdays: 08:00 to 13:00
• In the case of emergencies after hours call ER24 on 087 135 1248.
Call the Unity Health call centre on 0861 366 006 and ask for a provider request form. Fill out the
What if the member’s existing GP
form with the member’s GP details and email to Unity Health at networks@unityhealth.co.za. Unity
is not a network provider?
Health will contact the member’s GP and advise the member whether the GP decided to join or not
The member has access to the Unity Health website portal. The member has to go onto
www.unityhealth.co.za and register to gain access to search for a provider close to them via the
There is no network provider
Unity Health unique GEO mapping tool. The member can also contact Unity Health on 0861 366 006
close to where the member lives?
or email at networks@unityhealth.co.za. Unity Health will forward the member a list of providers
closest to them.
Unity Health provides their members with the options to download a mobile app. The Unity Health app
offers useful features such as:
1. An emergency button for easy emergency assist;
2. Tracking the member’s GP visits, medication, and other claims;
How does a member access their 3. Finding the member’s closest GP, Dentists or Optometrist;
Unity Health app? 4. The member’s digital membership card with their membership details;
5. A useful summary of the member’s plan details, benefits and limits;
6. The member’s personal details;
7. Contact details for any enquiries;
8. FAQs.
What is the difference between A dispensing provider will provide the member’s medication during their consultation and they will not
a dispensing and non-dispensing need a script to go to the pharmacy. A non-dispensing provider will provide the member a script during
provider? their consultation and they will need to go to a Mediscor pharmacy to collect their medication.
What does a member do The member should contact the Unity Health call centre on 0861 366 006 and select the option for
if a benefit requires pre-authorisations. The benefit needs to be pre-authorised by Unity Health before the member can
pre-authorisation? access the benefit.
In most cases the member simply presents their Unity Health membership card and ID to the provider
and the provider will submit the claim directly to Unity Health for processing and payment. In isolated
How are claims settled? cases, if the member did pay the provider directly, they may fill out a reimbursement form and email
Unity Health at claims@unityhealth.co.za with all supporting documentation within 6 months from
the date of treatment. Unity Health will assess and reimburse the member in respect of all valid claims.
An “emergency” is an event of a sudden, and at the time, unexpected onset of a health condition that
What is an emergency? requires immediate medical or surgical treatment, where failure to provide medical or surgical treatment
would result in serious impairment to bodily functions or serious dysfunction of a bodily organ or would
place the person’s life in jeopardy. Examples include heart attacks, strokes.
1. Call Unity Health call centre on 0861 366 006 or ER24 on 087 135 1248.
2. ER24 will verify the membership of the person in need of help, whether it be the main member
or a dependant.
What does the member do in the 3. ER24 will assist the member with advice, and emergency transportation to their nearest
event of a medical emergency or in-patient hospital facility.
serious accident? 4. ER24 will issue the hospital with a guarantee of payment and the member will be admitted
for treatment.
5. Unity Health will then settle the account directly with the hospital, subject to the
benefit limitations.
Page 08Question Answer
A benefit equal to the cost of in-patient hospital treatment in a hospital emergency or casualty
unit, provided that such treatment is in the event of an emergency. Stabilisation for the medical
What does emergency
condition, e.g. appendicitis in the emergency unit would be covered under the Stabilisation benefit, but
stabilisation mean?
admission to hospital for surgery would not be covered. In terms of your policy, it is the immediate
treatment administered to a person in an emergency, to stabilise the patient before they are transferred
to a State facility for further management.
An emergency department, also known as an accident and emergency department, emergency room
What is an emergency casualty (ER) or casualty department, is a medical treatment facility specialising in emergency treatment without
department? prior appointment; either by their own means or by that of an ambulance. The emergency department
is usually found in a hospital or other primary care centers.
Yes, the member can contact ER24, the designated provider on 087 135 1248 or Unity Health call
Is the cost of the ambulance
center on 0861 366 006 in the event of an emergency or serious accident. Once the member has been
service covered?
transported to the nearest hospital, the hospital should contact Unity Health.
“Accident” means bodily injury caused by violent accidental and external physical means. Examples
What is an accident?
include, motor vehicle accidents, severe burns, exposure to poisons.
1. Call the Unity Health call centre for a list of the nearest out-patient facilities that accept
guarantee of payments, as some out-patient facilities only accept cash.
2. The Member must please ensure that they have their Unity Health membership card and ID
What does the member do in the
for verification purposes.
event of a minor accident?
3. ER24 will arrange the guarantee of payment with the out-patient facility.
4. Unity Health will then settle the account directly with the out-patient facility, subject to
the benefit limitations.
The member must visit their Network GP who will consult with them and prescribe their chronic
medication accordingly (existing or new chronic conditions).
The Network GP will assist you by one of the following methods:
What is the process for applying 1. Network GP to Contact Chroniline on 086 011 9553 to obtain telephonic authorisation on
for chronic medication? behalf of the patient.
2. Network GP can fax a copy of the prescription to 086 615 1509 with the member’s details
reflecting on the script.
3. Network GP can email a copy of the prescription to preauth@mediscor.co.za.
A formulary is an approved list of medication that has been approved by Unity Health. The member can
What is a formulary? normally find both generic and brand name drugs in formularies. Formulary prescription medication is
chosen for its cost, effectiveness and safety. Non-formulary drugs will be for the member’s own cost.
Where does a member collect Once the member’s chronic medication has been approved, they may collect it from any Mediscor
their medication? pharmacy which includes Clicks, Dischem and Pick n Pay.
Can the member buy medication
No, the member can only get medication from a pharmacy with a script from a Unity Health network
over the counter (OTC) without
GP.
a script from a GP?
Unity Health has an open network of dentists i.e. the member may consult with any dentist of their
How does a member access their choice. Once at the dentist, the member has to present their membership card and ID document.
dental benefits? The provider needs to contact the Unity Health call centre at 0861 366 006 for confirmation of
benefits.
For employer groups, any employee may join as long as they are actively employed. If the member is an
Can anyone join Unity Health? individual member that wants to join in a private capacity they can join, the member needs a valid ID or
passport and proof of banking details.
31 Days written notice must be provided to Unity Health via email to: membership@unityhealth.co.za
How is cover cancelled?
or faxed to 011 706 5568.
What are the tax benefits to the The employer may deduct their share of the Unity Health premium payment expense and receive
employer? corporate tax relief of 28% (or at the applicable corporate tax rate).
Does Unity Health issue tax Unity Health does not issue tax certificates. The reason for this is that Unity Health operates health
certificates? insurance products which do not have any tax benefits to the individual taxpayer.
Is the member covered for
No, international cover is not provided.
overseas travel?
Unity Health is rated annually with adjustments taking effect on 1 January of every year, however, we do
Will the policy premium be
reserve the right to adjust the premium with 31 days written notice.
adjusted and how frequently will it
Adjustments are based on various factors including but not limited to loss ratio experience, medical
be adjusted?
tariff increases and inflation, changes in the group demographic profile and benefit changes.
Page 09Question Answer
Benefit coverage will be suspended and any claims submitted during the time of suspension will only be
What happens if the employer paid once premium payments are up to date.
does not pay premiums on time? If premiums are not paid for 2 consecutive months and there are no attempts to pay arrear premiums,
the policy will be cancelled.
A claim may be disputed by:
1. Making representation to Unity Health or the Insurer indicated in the Disclosure Notice attached
to the policy wording within 90 days of receipt of the benefit/rejection letter. Unity Health or the
insurer is obligated to provide the member with feedback within 45 days. The member should first
If the member wishes aim to resolve their dispute with Unity Health before contacting the Insurer.
to dispute the claims assessment, 2. The member may also contact the Financial Service Ombud indicated in the Disclosure Notice
what procedures need to be attached to the policy wording should they not be satisfied with the response of the Insurer.
followed and within what time i. The FAIS Ombud may also be contacted for any complaints against the member’s broker.
frame? ii. The Ombud for Short-Term Insurance may also be contacted for any complaints against
the insurer.
The member may also constitute legal action should the matter not be resolved by either the insurer
or the relevant Ombud. The claim will prescribe 6 months after the expiry of 90 day period indicated
above (no further clams will be payable for the specific claim).
Does the member need to nom-
Yes, the member must complete the accidental death beneficiary form and send it to:
inate a beneficiary to receive the
membership@unityhealth.co.za or fax it to 011 706 5568.
accidental death benefit?
The member’s beneficiary nomination form has been sent to them in the welcome pack. The member
Where does the member obtain a can also register and log into the Unity Health web portal www.unityhealth.co.za, where they will have
beneficiary nomination form? access to all their forms. Alternatively, call Unity Health’s call centre on 0861 366 006 and one of our
friendly call centre agents will forward the form to the member.
Unity Health prints and dispatches the member’s card after their first premium has been paid. If the
Who should the member contact member does not receive their card within 30 days after the first premium is paid, they should contact
if they have not received their Unity Health on 0861 366 006 or email membership@unityhealth.co.za. Unity Health does email
membership card? members their membership certificates which are used to access benefits prior to receiving their
membership cards.
Unity Health encourages the member to access Unity Health’s Dashboard online portal to access the
following:
1. membership certificate;
How do members access 2. access to the member’s information loaded on Unity Health’s system;
information regarding a status 3. claims received,processed and paid;
of a claim or if they need to 4. access to all communication, policy document and brochures.
search for service providers?
If the member has not yet registered on Unity Health’s Dashboard online portal, please visit the website
www.unityhealth.co.za to register. If the member requires more information regarding the use of
Dashboard, please contact Unity Health Call Centre on 0861 366 006.
Distinguishing factors
1. Benefits for the main member and their dependants
2. No maximum on the number of child dependants
3. No co-payments, we settle claims directly with network providers
4. Unity Health membership card, recognised by all network providers
5. Unlimited network doctor visits on Plan C
6. Members do not need to nominate a network provider, they may visit any provider on the Unity Health Network
7. Members may go to any private hospital
8. Unlimited emergency and evacuation services through ER24
9. Unity Health call centre, for any claims/membership related queries
Unity Health is a division of Ambledown Financial Services (Pty) Ltd. FSP 10287 Underwritten by Constantia Insurance Company Limited, an authorised FSP 31111
Page 10Call Centre: Claim: Physical Address:
0861 366 006 claims@unityhealth.co.za Ambledown House, Eton Office Park East
c/o Sloane & Harrison Street,
ER24 - Emergencies & Membership queries: Bryanston, 2191
Hospital Admissions: membership@unityhealth.co.za
087 135 1248 Postal Address:
Correspondence & general queries: PO Box 1862, Cramerview 2060
Facsimile: correspondence@unityhealth.co.za
011 706 5568
Website:
New Business: www.unityhealth.co.za
newbusiness@unityhealth.co.za
This brochure is for information purposes only. Any claim is subject to the actual policy document.You can also read
